1. Making Medicine Mercury Free Implementing a Mercury-Elimination Plan MMMF Award Process

2. 2 Why Bother? AHA/EPA Goal to Eliminate Mercury in health care. – Goal of 50 MMMF awards in next round! Ethical responsibility/Mission Statement Environmental/Public Health Regulatory Compliance/Liability Safety Press coverage and awards Community Relations Patient/Employee satisfaction Potential Cost Savings

3. 3 www.h2e-online.org

4. 4 Obstacles to Mercury Elimination Mercury is considered the Gold Standard Clinicians are trained on mercury devices Cost of replacements Old habits

5. 5 Be like Mercury – Persistent! Designate team leader Pilot – Start Small if you need to Take a team approach – include multiple departments Check with your GPO – We’re driving markets! Educate

6. 6 Environmental/Health Impact Medical waste incinerators are major source of mercury AHA-EPA Memorandum of Understanding - 1998 FDA and state fish consumption advisories New York Academy of Sciences Report National Resource Council (NRC) Report AMA, ANA, APHA resolutions

7. 7 The Fish Connection

8. 8 Clinical Sources Sphygmomanometers Thermometers Barometers Bougies, cantor tubes Pharmaceutical Preservatives

9. 9 Facilities Management Light Bulbs Switches Thermostats Batteries, electronics

10. 10 Laboratories Sources Laboratory chemicals Thermometers Cleaning chemicals

11. 11 But First…Manage what you have! Education Segregation Labeling Spill Response Monitoring Removal Record keeping

12. 12 Shut the Door to Mercury Identify mercury-containing products purchased for your facility Prioritize items – Major source is sphygmomanometers and cantor tubes. Identify/pilot alternatives to mercury- containing products Develop a policy for mercury elimination plan Educate department heads and purchasing agents Monitor and track. Newsletters, education

13. 13 H2E National Awards Making Medicine Mercury Free Partners for Change Partner Recognition Environmental Leadership Award Champion for Change Internal Awards Process

14. 14 MMMF Award Facts You have to be an H2E partner. You can apply any time during the year. This is a one-time award. You don’t have to be 100% mercury free to be eligible. H2E can walk you through the process. H2E will inform you in 30-60 days.

15. 15 MMMF Award Application Click on MMMF form and save as a file. http://www.h2e-online.org/pubs/awards/MmmfForm60.dochttp://www.h2e-online.org/pubs/awards/MmmfForm60.doc. Click on Annual Summary & Goals Form and save as file www.h2e-online.org/programs/partner/p_goals.dot Provide back-up documentation Send in via email wherever possible and send in mail back-up information. Contact H2E for more information. 1/800-727-2179 or h2e@h2e-online.org

16. 16 Facility Information (S&G form) Section 2: Adjusted Patient Days per month Number of beds # of Outpatient Visits for Amb. Sites Long-term Care - # of beds Adjusted patient days = TTL patient days X (TTL Patient Revenue (Inpatient + outpatient)/Inpatient Revenue # of beds = # of staff beds. Admitting or finance will have this data Section 3: Facility Waste Assessment Summary

17. 17 Facility Waste Assessment Summary (S&G Form) Section 4: Mercury Assessment Section 5: Environmental Policies Questions regarding formal policies on environmental commitment and environmentally preferable purchasing. For information on how to evaluate mercury use and implement activities to eliminate mercury from your facility’s waste stream, download the H2E self-Assessment Guide at www.h2e-online.org. See Sections 5A and B in the guide. Setting new H2E goals. H2E goals – Finishing off last bits of mercury Set new goals that may not be related to mercury work.

18. 18 MMMF Award Application Award Application Check List 1. Mercury Elimination Policies 2. Mercury Management Policy 3. Environmentally Preferable Purchasing

19. 19 MMMF Application – Clinical Devices Replaced Thermometers Replaced at least 75% sphygmomanometers Replaced at least 75% clinical devices

20. 20 MMMF Award Application - Facilities Recycle Bulbs Battery Collection Inventoried and labeled mercury- containing devices and plan to replace.

21. 21 MMMA Application - Labs Replaced B5/Zenkers stains Inventoried mercury-containing lab chemicals with plan to substitute. Inventoried thermometers, replaced at least 75% and phase-out plan in place Other chemicals – Pharmacy, dental, cleaning chemicals Other projects

22. 22 MMMF Award Check-List Partner of H2E Annual Summary and Goals Form MMMF Award Application No outstanding OSHA violations 3 copies of everything Back up/Supporting information Email and send in regular mail

23. 23 H2E Resources/Guidance Awards Process: www.h2e-online.org/programs/award/index2004.htm Mercury Recyclers – www.h2e-online.org/tools/hg-recy.htm Consultants – www.h2e-online.org/tools/consult.cfm Vendors – www.h2e-online.org/tools/vendors.cfm Mercury Backgrounder – www.h2e-online.org/tools/mercury.htm List serve: www.h2e-online.org/programs/list.htm Universal Waste Guidelines – www.h2e-online.org/tools/univwaste.htm 10 steps to bulb recycling – www.h2e-online.org/tools/univwaste.htm#flu Mercury Elimination Plan – www.h2e-online.org/pubs/mercurywaste.pdf Fish Advisories – www.h2e-online.org/tools/merc-oth.htm#fish

24. 24 Other Mercury Resources Massachusetts Academic & Scientific Community Organization – www.masco.orgwww.masco.org U.S. Food & Drug Administration - www.cfsan.fda.gov Health Care Without Harm’s Fast Facts - http://www.noharm.org/library/docs/Going_ Green_The_Mercury_Problem_-_Fast_Facts.pdf HCWH Making Medicine Mercury Free Resource Guide - http://www.noharm.org/library/docs/Going_ Green_Making_Medicine_Mercury_Free.pdf Measuring Blood Pressure Accurately – http://www.noharm.org/mercury/sphygmo American Medical Association – www.ama-assn.org

25. 25 Need Help? Hospitals for a Healthy Environment www.h2e-online.org 800/727-4179 Partner Coordinator - Janet.brown@h2e-online.org 212/941-2486- Janet.brown@h2e-online.org Champion Coordinator – Sarah.obrien@h2e-online.org 802/479-0317 State Program Coordinator Cecilia.deloach@h2e- online.org 202/234-0091 Director Laura.brannen@h2e- online.org 603/643-6700